Healthcare Provider Details

I. General information

NPI: 1013215201
Provider Name (Legal Business Name): DAVID LAWRENCE-HAWLEY LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/11/2011
Last Update Date: 11/18/2024
Certification Date: 11/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

61 S MAIN ST STE 214
WEST HARTFORD CT
06107-2486
US

IV. Provider business mailing address

140 N FRONTAGE RD
MANSFIELD CENTER CT
06250-1648
US

V. Phone/Fax

Practice location:
  • Phone: 860-969-2399
  • Fax: 860-215-3016
Mailing address:
  • Phone: 860-456-2261
  • Fax: 860-450-1357

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number5572
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: